Rowan Williams: In God's World There Is No Right To Die

This week the House of Lords will debate Lord Joffe's Assisted Dying Bill.  Lord Joffe proposes a bill that would "enable a competent adult who is suffering unbearably as a result of a terminal illness to receive medical assistance to die at his/her own considered and persistent request".  BBCi reports churchleaders speaking out against the Bill today and the Mail on Sunday carries an article (not currently available online) from the Archbishop of Canterbury, Dr Rowan Williams. 

Dr Williams believes that the ADB - motivated, in part, by the pressures discussed in this blog's previous post - will fundamentally altar the law's relationship with the citizen.  Up until now, Dr Williams notes, the law "has always been what guarantees the security and lives of citizens, irrespective of quality of life or life expectancy."  If the ADB were to become law, the Archbishop warns, and it becomes lawful for a doctor or other private citizen to bring about the death of another private citizen, "we are in uncharted waters".

Dr Williams asks some penetrating questions of those who would support the legalisation of 'assisted dying' and they are listed below.  The summary words in red are my own.

1. The end of the 'do no harm' principle: "If we say that people have a right to die in some circumstances, does this create a duty on the part of doctors and nurses to bring about death?"
2. Conscientious objections: "What are the safeguards for the right of medical professionals to refuse [to end a patient's life] on conscientious grounds?"
3. Patient-doctor trust: "What will be the effect of legislation be on trust in the medical profession?"
4. A right-to-die becomes a duty-to-die: "Will there be a suspicion or fear that pressure will be brought to bear on those in terminal or extreme conditions to ask for 'assisted dying'?"
5. Resource constraints lead to euthanasia : "Will individuals or their families - not to mention doctors and nurses - be able to cope with the feeling of unspoken pressure to save scarce resources?"  The Archbishop of Canterbury notes that elderly people are already moving away from Holland and Switzerland (where voluntary euthanasia is legal) because of fears of what might happen to them when they need medical care. 
6. Legal euthanasia reduces the incentive to invest in pain control and other medical research: "Can we be sure that high-quality research will continue into ageing, dementia and pain control, when there is a swifter and less costly option available in the form of 'assisted dying?'" and similarly, "Will this legislation undermine investment in palliative provision?"

Dr Williams does not believe that life should be prolonged inhumanely.  He accepts that doctors often give pain-killing drugs in the knowledge that such treatments will hasten death.

A "moral watershed" will be crossed, however, if the medical profession is granted legal permission to "initiate a process where the primary and explicit purpose is to end life."   

Comments

[Derek]

Dr. Williams accepts that doctors can give high doses of pain-killers which do hasten death. Once that has been accepted it is a matter of where to draw the line. Personally I believe it is a matter that needs to be made by each individual in discussion with their own doctor. No doctor should be forced to carry out any treatment that he feels is not right, and no patient should be forced to endure a life that is unbearable. The best thing to do is to draw up a living will.

[James Hellyer]

Dr. Williams accepts that doctors can give high doses of pain-killers which do hasten death. Once that has been accepted it is a matter of where to draw the line.

There is a big difference between administering pain killers that shorten the patient's life as a side effect, and administering a drug with the aim of shortening someone's life.

[Samuel Coates]

There's some discussion in the LibDem youth forum about the Dutch Liberal proposal to provide suicide pills (for suicidal people, not sickly in particular) Scary.

[Simon C]

This "double-effect" argument is one of the most misunderstood arguments in relation to euthanasia. Research has demonstrated that increasing opiod dosage in the last week of life does NOT accelerate death.

Patients build up resistance to opiods. So, it would take a much larger dose to kill a frail, light 90-year old who had been taking opiods regularly to control pain than it would to kill a 6 foot 3, (slightly) overweight 39- (still) year old like me, who has not been taking opiods at all.

Palliative care consultants, when assessing an individual patient, are acutely aware of the difference between asking themselves: "how much do I need to administer to kill the pain?" and "how much would kill the patient?"

The House of Lords Select Committee that considered the Joffe Bill did not reach a conclusion on the slippery slope. However there is clear evidence that is capable of supporting slippery slope argments, particularly from Holland, where infants are now being euthanased. We need to explore that evidence and reach a conclusion on it.

The issue, in the end, comes down to this: at present our national morality and medical practice is based on the premise that in no circumstances is it right deliberately to take a life. Once assisted suicide or euthanasia become legal, we will be saying as a society that there are circumstances in which it is a good outcome to intervene and take a life.

Lord Joffe's interview on Today gave a foretaste of this. The lethal does was described as "medicine". At the moment, patients take medicine to make them better. In the future, they might take medicine to kill themselves.

Our society must ask itself whether this is the future that it wants.

[Simon C]

"no patient should be forced to endure a life that is unbearable."

Derek, how do you measure objectively when suffering has reached the "unbearable" stage, so as to trigger the entitlement to die? - suffering is by definition subjective. The House of Lords Select Committee found that the concept of "unbearable" suffering was not an effective test.

Would you think that somebody suffering to an extreme degree from depression, so that they felt suicidal, should be treated or helped on their way?

[Selsdon Man]

A free individual owns his or her body and life. If not, he or she is effectively a slave. This is why the state should not have the right to take your organs when you die. The right to end one's life, or to instruct a doctor or other person who is willing to do so, is a basic human right.

There are protections in the Assited Dying Bill to deal with most of the editor's points. There are, however, important life insurance and assurance issues that need to dealt with.

[comstock]

"Would you think that somebody suffering to an extreme degree from depression, so that they felt suicidal, should be treated or helped on their way?"

Sorry, but thats *absolutely* irrelevant IMHO.

We are talking about physical illness here ....incurable, terminal physical illness which is causing extreme suffering. Nothing else.

[Editor]

We are at the moment Comstock but that's how Holland started. They're now discussing infanticide of very sick and disabled babies.

[Rick]

Time to Google

Go "T-4", "Brandt + Euthanasie" "Hadamar" and see how far "Modern" Europe has been shaped by that Austrian dictator...........simply ahead of his time by the look of things

[Simon C]

Selsdon:

The Select Committee effectively found (although it was too polite to say so expressly) that the safeguards set out in the Bill were inadequate. For example, the requirement that a patient be experiencing "unbearable suffering" required a doctor to assess objectively something that is by its very nature subjective. The definition of "terminally ill" did not meet clinical realities either. There are further examples, but these are the two most difficult to define in an enforceable and certain way.

As to the rights argument, may I refer you to my earlier Platform blog on this? (Editor, perhaps you could put a link in?) This is a very good example of what I meant. People are free to commit suicide if they want to. But society would take active steps to discourage or prevent them from doing so. We certainly don't recognise an entitlement to commit suicide, which is what you are contending for.

Your argument is that unless you have full autonomy you are a slave. That is simply not correct. As the Select Committee recognised, autonomy is not an overwhelming trump card that beats all other considerations. The issue lies in where to draw the line.

Comstock:

Please read the draft Bill:

http://www.publications.parliament.uk/pa/ld200304/ldbills/017/04017.iii.html

You will find that in section 1, suffering is defined as including suffering "by reason of pain or otherwise". In other words it goes well beyond physical pain.

That is not surprising. Good palliative care means that those who access it (and far more needs to be done to extend that) can have their physical symptoms managed. As the Select Committee recognised, the argument has moved away from the concept of pain towards arguments based on autonomy - the claimed entitlement to choose how and when you die.

PS: Apologies to those who may have spotted a different version of this post that appeared for a few hours overnight. It was badly written, did not express what I wanted to say (in fact managed almost the opposite), and the Editor kindly withdrew it. A salutary reminder about the need not to blog on returning home late at night almost 16 hours after I left!

[Selsdon Man]

"We are at the moment Comstock but that's how Holland started. They're now discussing infanticide of very sick and disabled babies."

That would surely be illegal under European human rights legislation.

[Simon C]

Selsdon,

Your faith in the operation of the ECHR is touching.

Doctors in Groningen announced in December 2004 that they had performed euthanasia on infants, and produced “The Groningen Protocol” – guidelines on infant euthanasia – which they hope to persuade the government to adopt, to avoid prosecution. See for example: http://www.timesonline.co.uk/article/0,,8122-1586066,00.html

[Selsdon Man]

"PS: Apologies to those who may have spotted a different version of this post that appeared for a few hours overnight. It was badly written, did not express what I wanted to say (in fact managed almost the opposite), and the Editor kindly withdrew it. A salutary reminder about the need not to blog on returning home late at night almost 16 hours after I left!"

Hope you had not been binge drinking!!

[Selsdon Man]

Going back to serious matters Simon, I will take another look at the Bill. I still believe in self-ownership - a human being owns his/her life and body and has the right to do with it as he or she wishes and takes responsibility for his or her actions. The alternative is to give the state the right to run our lives - as collectivist and paternalist conservatives want to.

[Simon C]

Selsdon, It's not as clear-cut as that. Do you belive that we are defined by autonomy, or by our relationships with other people - or indeed by something else? We will never have complete autonomy - we have social conventions, laws, manners, politeness - all of which restrict us in one way or another, but none of which necessarily make us slaves. We need some social framework to prevent us from the tyranny of anarchy.

[Simon C]

Binge-drinking? - if only!!

We are off to Spain next week for 2 weeks (I know, I know, but back in February it seemed like a good time to go away, & a friend has promised to text me the leadership vote results) & I hope my children might allow a little binge sleeping.

[Simon C]

Binge-drinking? - if only!!

We are off to Spain next week for 2 weeks (I know, I know, but back in February it seemed like a good time to go away, & a friend has promised to text me the leadership vote results) & I hope our children might allow a little binge sleeping.

[Selsdon Man]

"We will never have complete autonomy - we have social conventions, laws, manners, politeness - all of which restrict us in one way or another, but none of which necessarily make us slaves. We need some social framework to prevent us from the tyranny of anarchy."

Agreed Simon but the state does dictate or enforce social conventions and politeness. They are the product of volunatry association of free individuals. Civil society develops from the bottom up - individuals, families, local communities and nations - rather than top down. The idea that individualism is atomism is complete nonsense and spread by aithoritarians who want to control our lives - David Willetts is a prime example.

Have a good holiday in Spain.

[Derek]

Suicide is an option for those who are capable of carrying out the act, but those who are rendered incapable due to their physical condition do not have that option. Instead they are at present forced to rely on friends or relatives taking them to Switzerland, where doctors are permitted to assist those who wish to die. Why should those people not be able to access that service themselves in this country? The freedom to die should not be denied to the most vulnerable people.

[Rick]

"The freedom to die should not be denied to the most vulnerable people "

It wasn't denied my relative; never even had to ask. The benevolent and munificent German State took care of it all and her mother had nothing more to do than accept the urn of ashes and believe they had once been her daughter.

http://tinyurl.com/dno8t

Apparently the Bishop of Munster that Rome is currently beatifying August Clement Graf von Galen blew the whistle on this and they had to find other ways.

[Rick]

http://www.touchstonemag.com/archives/print.php?id=14-10-030-f

M. Burleigh, Death and Deliverance: "Euthanasia" in Germany 1900-45

http://wings.buffalo.edu/faculty/research/bioethics/brf-rot2.html

The Burleigh book is essential reading

[Rick]

"The freedom to die should not be denied to the most vulnerable people "

Those words must be a quotation from Dr Brandt............it cannot be but a translation of some Nazi slogan.

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